Hall Render

MARCH 11, 2025

The magnitude of harm : While the government was harmed, the actual damages were quantifiable at $2.75 Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations.

Medicare 52

Medicare Medicare Governance Fraud 52

Healthcare IT Today

MARCH 27, 2025

The following is a guest article by Luke Rutledge, President at Homecare Homebase The allure of AI in healthcare is undeniable. Without strict governance, AI tools could inadvertently violate HIPAA and other healthcare privacy laws, placing patient confidentiality at riskmissteps that are not easily forgiven.

Governance 64

Governance Compliance HIPAA Regulatory Compliance 64

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

Fraud 72

Fraud Medicare Medicare Overpayments 72

AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags When Audit Managers Knowingly Skew Audit Results as this article is Part 2, the rest of the story.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Healthcare IT Today

SEPTEMBER 21, 2022

The following is a guest article by Mandy Fogle, Healthcare Value Engineering at Shift Technology. New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it.

Fraud 61

Fraud COVID-19 Medicare Medicare 61

AIHC

JUNE 14, 2024

Part 3 in a series of articles to support World Elder Abuse Awareness Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance ( AIHC ), a non-profit healthcare education organization. These scams are outlined in more detail below.

Fraud 52

Fraud Elder Abuse Governance Compliance 52

Healthcare IT Today

MARCH 26, 2025

The following is a guest article by Josh Rosaasen , Chief Operating Officer at Locke Bio The rise of direct-to-consumer ( DTC ) telehealth services has revolutionized how patients access medical care and prescriptions. The rise of telehealth has also led to increased scrutiny over prescription fraud and misuse.

FDA 52

FDA Compliance Licensing Fraud 52

Healthcare IT Today

JANUARY 19, 2024

The following is a guest article by Steve Gwizdala , VP of Healthcare at Ping Identity The healthcare security landscape has become an increasingly critical concern. Governments are starting to act in response to the growing amount of cyber threats in the healthcare industry. AI should also be used for identity governance.

Fraud 123

Fraud Governance Ransomware Compliance 123

Healthcare IT Today

APRIL 23, 2020

The following is a guest article by Mark LaRow, CEO at Verato. While the federal government has relaxed some patient privacy rules in response to the coronavirus pandemic, there are still avoidable mistakes healthcare professionals make when it comes to protecting patient data.

Public Health 124

Public Health Governance COVID-19 Fraud 124

Healthcare IT Today

FEBRUARY 9, 2024

government and leading medical associations call upon stakeholders to do their part. Yet due to their complex nature, health payers, third-party administrators, government agencies, and pharmacy benefits managers focus most of their constrained resources on auditing professional claims. In fact, studies by the U.S.

Fraud 128

Fraud Governance Hospitals Licensing 128

MedTrainer

JULY 31, 2024

Healthcare organizations of all sizes and types are increasingly adopting governance, risk, and compliance (GRC) frameworks to address the industry’s complex regulatory landscape and evolving challenges. The integration of GRC programs in healthcare has been significantly bolstered by technological advancements.

Governance 52

Governance Compliance HIPAA Regulatory Compliance 52

Healthcare IT Today

FEBRUARY 13, 2025

The following is a guest article by Richard Caralli , Senior Cybersecurity Advisor at Axio Cybersecurity regulations often emerge in response to major incidents.

Compliance 59

Compliance HIPAA Ransomware Fraud 59

HIPAA Journal

JANUARY 1, 2023

Many articles discussing what does HIPAA stand for fail to give a complete answer. However, few articles discussing what does HIPAA stand for explain how a bill with the objective of reforming the health insurance industry evolved into an act of legislation that now controls how healthcare data is safeguarded.

HIPAA 99

HIPAA Health Insurance Fraud Governance 99

Healthcare IT Today

DECEMBER 21, 2023

The following is a guest article by Mitchell Perry, VP Compliance & Security at Access In the ever-evolving landscape of healthcare IT in US healthcare frameworks, integrating electronic health records (EHRs) has become a cornerstone for providers. If healthcare providers fail to comply, the consequences can be costly.

Records Management 128

Records Management Regulatory Compliance Compliance HIPAA 128

Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

Healthcare IT Today

DECEMBER 30, 2024

Government-funded capitation has to ensure care is adequate. I’m a supporter of capitalism, however when the product or services do not align with the cost, the consumer’s options are handcuffed and being leveraged, and the government must establish some boundaries. We could not do this without all of your support.

US Department of Health and Human Services 91

US Department of Health and Human Services Nurses Medicare Medicare 91

Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. 3730(h)(1). Practical Takeaways.

Fraud 40

Fraud Governance Compliance 40

Verisys

APRIL 13, 2023

Harm isn’t just in the form of medical errors but can also be associated with healthcare fraud. In 2016, an article published by the British Medical Journal (BMJ) listed medical errors as the third cause of death in the United States. Up to 10% of federal healthcare funding is lost to fraud, waste, and abuse.

Fraud 52

Fraud Governance Compliance 52

Healthcare IT Today

DECEMBER 26, 2024

Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud. Thank you so much to everyone who took the time out of their day to submit a prediction to us and thank you to all of you for taking the time to read this article! Let us know on social media.

US Department of Health and Human Services 93

US Department of Health and Human Services Ransomware Compliance Hospitals 93

Healthcare IT Today

APRIL 25, 2024

The following is a guest article by Troy Hawes, Managing Director at Moss Adams The recent cybersecurity attack against Change Healthcare caused dramatic disruptions to one of the nation’s largest prescription processors. Troy is a frequent speaker and highly published thought leader on IT compliance and cybersecurity topics.

Ransomware 126

Ransomware Compliance Fraud Governance 126

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud.

Overpayment 89

Overpayment Overpayments COVID-19 Medicare 89

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. Only appeal claims when you have evidence and supporting documentation to substantiate your right to payment.

Fraud 52

Fraud Medicare Medicare Compliance 52

Health Law RX

JUNE 27, 2023

the Court held that, despite declining to intervene at the outset of a case, the Government retains the authority to intervene later, including for the purposes of seeking dismissal pursuant to and consistent with Federal Rule 41(a) ( U.S. Circuit found the Government’s dismissal authority to be “unfettered” ( Swift v. SuperValu Inc.,

Governance 52

Governance Fraud Compliance 52

AIHC

SEPTEMBER 25, 2024

There is value in learning from another organization’s lessons publicly posted by a government authority, such as the Department of Justice (DOJ), Centers for Medicare & Medicaid Services (CMS), the HIPAA enforcement agency, the Office of Civil Rights (OCR) or the Federal Bureau of Investigations (FBI). You may unsubscribe at any time.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

Healthcare IT Today

OCTOBER 16, 2023

To evaluate the benefits and challenges of each deployment scenario, healthcare organizations should consider risk factors around management, governance, security, and cost to ensure that the right applications move to the cloud at the right time. So much to think about here! We could not do this without your support.

Fraud 126

Fraud Governance Compliance Hospitals 126

HIT Consultant

SEPTEMBER 8, 2024

Small language models are more governed and specialized than LLMs How to Use SLMs in Healthcare The healthcare system contends with overworked staff and painfully extended wait times. Healthcare is a good candidate for SLMs because it uses focused medical data, not the entire contents of millions of miscellaneous articles.

Doctors 115

Doctors Fraud Nurses Governance 115

AIHC

SEPTEMBER 3, 2024

The American Institute of Healthcare Compliance (AIHC) offers articles on AI, resources to technology governance, and a 3-Part article series on the Basics of AI, Who Regulates AI and Risk. Click Here to access the AI articles. This voluntary guide is a document to be updated over time by the OIG.

Compliance Officers 52

Compliance Officers Compliance Fraud Medicare 52

Healthcare Law Blog

FEBRUARY 1, 2022

In the attached article , we highlight some of the key legal considerations that the digital health industry can expect in the coming year from the perspective of: (1) telehealth related laws and regulations, (2) FDA, (3) privacy and cybersecurity, (4) fraud and abuse, and (5) antitrust issues.

Fraud 52

Fraud FDA Governance HIPAA 52

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 Health Care Fraud Actions Medicare Advantage. Hall Render blog posts and articles are intended for informational purposes only. billion of the $2.68 billion in settlements and judgments.

Governance 71

Governance Compliance Medicare Medicare 71

Hall Render

FEBRUARY 25, 2022

Although only a small minority of Children’s Hospital patients would be subject to cost-sharing under government health care programs, the OIG noted that the arrangement could implicate the AKS and Civil Monetary Penalties Law Beneficiary Inducement prohibition because the removal of cost? Your primary Hall Render contact.

Fraud 40

Fraud Hospitals Medicare Medicare 40

AIHC

MAY 17, 2023

This article addresses various forms of fraud and how criminals’ prey on compromised citizens. Contributions to this article are made from the American Institute of Healthcare Compliance Volunteer Education Committee’s interview of a law enforcement official. States may have their own names.

Health Outcomes 52

Health Outcomes Fraud Compliance Governance 52

YouCompli

AUGUST 2, 2022

This month’s article looks at COVID enforcements.?? ?. Healthcare compliance history has shown that when the government disperses significant funds, audits and enforcement associated with the disbursement of those funds will shortly follow. Different kinds of fraud and abuse have sprung up in relation to vaccination cards.

COVID-19 Vaccine 52

COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Operation Brace Yourself was one of the largest healthcare fraud schemes investigated and prosecuted by enforcement agencies. The $73 million fraud scheme was discovered and busted. 

Fraud 52

Fraud COVID-19 Compliance Medicare 52

Florida Health Care Law Firm

JANUARY 31, 2022

Department of Justice and the myriad health care fraud task forces around the country? Recent Sentencing in Compounding Pharmacy Fraud Case. This past week, a Mississippi pharmacist was sentenced to 5 years in prison for defrauding TRICARE (the government healthcare payer for the U.S. BILLION in fraud nationwide!

Fraud 40

Fraud Governance 40

Hall Render

APRIL 29, 2024

The disclosure must be made to the Criminal Division of the DOJ and must occur before any other corresponding government investigation or civil enforcement in order to be truly voluntary. Practical Takeaways Health care fraud is specifically listed as a key enforcement area for the DOJ.

Fraud 40

Fraud Compliance Governance 40

Healthcare IT Today

SEPTEMBER 19, 2023

I would continue to advance CMS’ directive that by 2030 all Medicare and the bulk of Medicaid beneficiaries be in care engagements governed under a value-based contract. Let us know either in the comments down below or through sharing this article on social media! What current regulations do you think need to be removed or updated?

Hospitals 139

Hospitals HIPAA Nurses Governance 139

HIPAA Journal

SEPTEMBER 5, 2023

Among its objectives, the Act aims to address illegal and misleading online content, better protect Internet users from fraud, and provide more control over what personal data is collected and how it is used. The Digital Services Act is a new EU law that updates the existing EU Electronic Commerce Directive.

Compliance 56

Compliance HIPAA Governance Fraud 56